More on ICD-10 & Coding

Experts see minor hiccups with ICD-10 launch; expect problems to surface in coming weeks

Most coders will still be inputting a backlog of ICD-9 claims for up to two weeks.

Susan Morse, Managing Editor

Some said the change to ICD-10 was easier than expected; others vented their frustrations online, but if anything is certain, Thursday's rollout had everybody talking.

Ed Hock, managing director of The Advisory Board, said the switchover largely met expectations.

Hock spoke with dozens of providers in the morning and heard of only two problems, he said.

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[Also: ICD-10 arrives: Live updates, reactions from the first day of the code change]

One multi-hospital system in the Midwest reported its coding system had gone down, causing a slowdown. Its vendor software wasn't working, he said.

Another organization in the Northeast had a batch of claims getting initial denials because of a glitch in the implementation of its system that automatically denied ICD-9 codes.

Other experts said the denial of ICD-9 codes was a frequent problem through the day, especially as host systems crossed time zones.

"As Oct. 1 made it to the West Coast and Alaska …," said Bruce Hallowell, managing director of Navigant Healthcare. "When they did the conversion they were hitting errors. It's not a big deal, it went away."

[Also: ICD-10 angers doctor: 'It doesn't help the patient, it doesn't help us']

Most coders will still be inputting a backlog of ICD-9 claims for up to two weeks, according to Nate Seaman, associate vice president of product management for MedeAnalytics.

"No one is coding in ICD-10 today," said Hallowell. "They have a coding backlog."

On Thursday, providers dealt with system issues, which will be followed by productivity issues and then payment issues, Hallowell said. Providers are expecting payment glitches, he said.

"We're changing the wheels on a bus going 100 mph, there's going to be glitches," he said. "Don't get comfortable yet, it hasn't even started yet. We're not going to know how bad it is for another 15-45 days."

Worries include payers who are using old computer systems based on ICD-9 to base diagnostic-related group payments to hospitals, he said. Most payers did not reissue contracts and base their benefit structures under old ICD-9 system, Hallowell said.

Some payers will be "mapping back" the ICD-10 codes to ICD-9, according to Seaman.

"The problem is those limited number of codes have just expanded," he said. "They have to take the new code, map it back to old contract, and pay claims that way."

Providers are worried about increased denials, more scrutiny and an expensive appeals process, according to Seaman.

Meanwhile, some providers found they had enought to handle just dealing with Thursday.

"I had to argue with an insurance on the correct ICD-10 code for Prostate cancer," said Candace Somoza, billing manager at Arizona Center for Cancer Care. "The insurance rep was stating that the prostate cancer diagnosis code 185 converts to some ICD-10 code starting with an 'R' when in fact it should be 'C61'.  Every insurance this year has said that we do not need to request updated authorizations for patient's who have therapy that was authorized with an ICD-9 code and their treatments will overlap into October. That tells me that they are using some kind of diagnosis ICD9-ICD10 crosswalk to auto-assign the ICD-10 code to the existing authorization so that claims will tie to the authorization correctly and pay."

She's not taking any more chances.

"After the conversation I do not trust whatever crosswalks they are using and today we will be re-requesting all prior authorizations for patients with treatments carrying into October to ensure we do not get an influx of "no authorization" claim denials due to the diagnosis codes not matching."

Twitter: @SusanJMorse